Ohio > County (Court Of Common Pleas) > Tuscarawas > Dissolution Of Marriage
Financial Affidavit-Husband - Ohio
| Financial Affidavit-Husband Form. This is a Ohio form and can be used in Dissolution Of Marriage Tuscarawas County (Court Of Common Pleas) . |
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In the Court of Common Ple as Ge ne ral Trial Division Tuscarawas County, Ohio Name: Addre ss : J udge SS# : DOB: Ca se No. Telephone #: Drivers License #: Petitioner, -a nd- Name: Child Support Worksheet Addre ss : Financial Affidavit -Husband SS# : DOB: Telephone #: Drivers Licens e #: P e titione r, I, P etitione r Husband, , s ta te unde r oa th tha tthe following informa tion is comple te a nd a ccura te to the be st of my informa tion, knowle dge and be lie f: 1. I am em ployed at (include na me and a ddres s) 2. I e arn $ per hour/per wee k/per month. (circle one) 3. I w ork an av erag e o f hours pe r we e k. 4. I re ce ive une mployment compe ns a tion of $ per wee k/per month. (circle one) 5. I rece ive workers compe nsa tion or dis a bility ins ura nce be ne fits of $ per wee k/per month. (circle one ) per month/per year. 6. I re ceived othe r income in the a mount of $ (circle one ) Pa ge 1 of 2 American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2 I re ce ive this income from: (List s ource, including s elf-employme nt income if a pplicable) 7. My gros s income for la st yea r wa s $ 8. My yea r-to-da te gros sncome i for this ye ar is $ , through (date) 9. 1 do/do notha ve he a lth insurance ava ilable for the minor child(re n). (circle one) The ins urance cos ts $ per wee k/per month. (circle one ) A) The cos t to cove r myse lf only is $ per wee k/per month. (circle one) B) The extra cost to cover the child(ren) is $ per wee k/per month. (circle one ) I 0. I pa y work-rela ted/educa tion-re late d/e mploymet-tran inin g-rela ted/da y ca re expe nse s fo r the minor child(re n) of this ma rria ge in the a mount of $ per wee k/per month. (circle one) I 1. I am the biologica l pa rent of other minor child(re n) who live in my (numbe r of children) home . I rece ive $ pe r month in co urt-orde red ch ilduppor s t for the se othe r minor biological child(re n). 12. I pa y pe rce nt city income ta x. 13. 1 pa y union due s in the amount of $ 14. I pa y $ pe r month in co urt-orde redpous s al s upport to myx-wi e fe .15. I pa y $ pe r month in court-orde red childuppor s t for a nother child(re n).16. A S ha re d P a re nting P la n is /is not attache d to the P e tition tha t has be en file d with the Court. (circle one) S igna ture of Pe titione r Husba nd S worn to a nd s ubs cribe d in my pre sence this da y of 20 Nota ry Public Pa ge 2 of 2 American LegalNet, Inc. www.USCourtForms.com
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